Shutting Off Stomach Acid … What Could Go Wrong?
Patients often request “Don’t set the chair back too far, Doc, I have reflux.” Millions of people suffer from dyspepsia. It’s a catchall phrase describing heartburn, gas, indigestion, abdominal pain, bloating, belching, and reflux. Absent an ulcer, patients are most often prescribed proton pump inhibitors (PPIs) to reduce or eliminate stomach acid production. To someone suffering from the regurgitation of stomach acid (GERD), PPI’s eliminate the acid, and patients feel better. Unfortunately this doesn’t solve the problem.
At NYU, my physiology professor referred to the G.I. tract as ”Merely an appendage of the oral cavity.” To a first year dental student, it struck a chord. Maybe there was more to this dentistry thing than met the eye. Aside from speed eating or food gulping, many people experience dyspepsia as a result of excessive intake of refined carbohydrates, especially high fructose corn syrup (HFCS). It’s hard to find a processed food that doesn’t contain this cheap synthetic sweetener. Friendly Lactobacillus bacteria located in the small intestine help digest carbohydrates and starches but not completely. These undigested carbs are fertilizer for gas producing bacteria responsible for GERD. They invade the small intestine when acid production is lowered. Additionally, a large segment of the population can’t absorb fructose in the small intestine at all. These undigested carbs essentially become fertilizer for the gas producing bacteria responsible for GERD. They invade the small intestine when acid production for the small intestine is lowered. Why does this happen?
Bacteria in the large intestine don’t need oxygen; they’re anaerobes and survive by fermentation, a process which produces gas. The politically correct term is flatulence. When this socially unacceptable wind leaves the rectum it’s not painful, except to innocent bystanders. On the other hand when the intestinal gas gets released through the stomach into the esophagus it can lead to I which can be quite painful.
Shutting off acid production seems reasonable enough, but it creates serious side effects. Acid keeps the gas producing bacteria confined to the large intestine. Reducing the acid shield allows them to migrate north, invading and inflaming the walls of the small intestine. They feast on the undigested starches and carbohydrates like HFCS. Fermentation produces enormous amounts of gas in the small intestine (where it doesn’t belong). The amount of carbohydrates in one slice of bread results in the formation of 1.5 gallons of gas. A slice of cheese pizza about 3 gallons. As this gas exits the small intestine and moves up through the stomach, acid is forced out of the stomach and into the esophagus resulting in GERD. When we cut off or neutralize stomach acid, it allows more potentially harmful bacteria to survive. This bacterial invasion from the large intestine overwhelms the indigenous, protective Lactobacillus. PPI’s reduction of stomach acid also allows pneumonia organisms to overgrow and colonize the upper small intestine. As gas is released through the mouth, pneumococcus bacteria are inhaled and colonize in the lungs. A study reported in the Journal of the American medical Association (JAMA) showed patients using PPI’s (Nexium, Prevacid, or Prilosec) were 89% more likely to develop pneumonia. Those taking acid reducing drugs such as Tagamet or Pepcid, 63% more likely. FDA recommends NO MORE THAN TWO WEEKS of continuous PPI use or 42 days annually. Both guidelines are routinely violated. Acid is necessary to digest protein. Vitamin B12 and Iron assimilation require an acidic environment. Lacking acid, calcium and magnesium absorption are impaired, leading to an increased risk of hip, wrist, and spinal fractures. JAMA reports taking PPI’s for more than a year results in a 44% greater hip fracture risk. New evidence suggests an association between PPI use and kidney disease, cardiac disease and a 44% increased risk of dementia especially in the elderly.
Discontinuing long-term use of PPI’s usually causes symptoms to return with a vengeance. This is actually a rebound phenomenon or an increase in acid secretion above levels prior to starting therapy. Some doctors think this indicates a need to increase dosages. Not true! PPI’s create DEPENDENCE over the long term. The body reacts to suppression of acid production in the stomach by trying to make MORE acid. The patient essentially is hooked on their drug. Over time these drugs can cause the very problem they are meant to treat. Discontinuing PPI’s should be supervised by a knowledgeable integrative physician. It’s the smart thing to do.
Stay well, Dr. Bill Ardito, D.D.S. – Sunshine Dentistry AZ